Challenges in Cardiovascular Risk Prediction and Stratification in Women
- There are significant sex specific differences in the cardiovascular (CV) risk factor profiles, presentation, and treatment of CVD for women compared with men. Mortality associated with cardiovascular disease (CVD) is declining in women, but at a slower rate than in men. Furthermore, women with heart disease have worse outcomes than men. Research has shown that there has been arise in CVD mortality in female patients younger than 55 years.
- There is a great “perception gap” between the lifetime CVD risk for women compared with men and this is impeding the attainment of improved CVD outcomes for women. This risk misperception is more prominent among women with the current rate of awareness among women that heart disease is their #1 threat is only 55%. Nearly 71% of women never raised the issue of heart disease with their physician. Furthermore, few women understood the relationships between heart disease and autoimmune disorders, pregnancy complications, early menopause, and irregular periods
- In addition, there is a significant sub-optimal CV risk awareness amongst physicians and cardiologists for women compared with men. Research has shown that physicians are more likely to assign a lower CVD risk to female patients compared with risk-matched male patients, are more likely to underestimate the probability of CVD in women. In a recent WHA survey among primary care physicians (PCPs), heart disease was not their top priority in women. PCPs ranked heart disease after weight issues and breast health for women. Only 49% of PCPs and 59% of cardiologists reported that their medical training had prepared them to assess the cardiac risk in their female patients. Furthermore, more than 90% of PCPs and cardiologists overwhelmingly agreed with the statement “women can present with different signs and symptoms of heart disease than men.”
- Despite men and women having some similar traditional CV risk factors, there are several additional sex specific CV risk factors for women compared to men. Men and women share similar modifiable traditional risk factors for CHD (diabetes, smoking, elevated cholesterol level, hypertension, sedentary lifestyle, obesity), however several of these risk factors are ‘more potent’ in women. Sex-specific risk factors are associated with an increased risk of heart disease, such as, early menopause, inflammatory diseases [systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA)], and complications of pregnancy (preeclampsia and gestational diabetes).
REFERENCE: Henry S, Bond R, Rosen S, Grines C, Mieres J. Challenges in cardiovascular risk prediction and stratification in women. Cardiovascular Innovations and Applications. 2019 Feb 1;3(4):329-48.
The Cardiaction Fitness and Health Program addresses the critical problems preventing women receiving the best CV risk assessment and management to optimise their CV health. CV risk assessment and management is a very complex process, and this is compounded by sex specific factors.
The Cardiaction program can, using the associated mobile app, improve their CV health literacy of women using simple, easy to understand language. Since this program is based on a ‘Systems Biology’ approach it can be tailored to incorporate the several additional sex specific CV risk factors for women compared to men.